Contemporary Approaches to Middle Turbinate Management: Balancing Preservation and Resection in Endoscopic Sinus Surgery

The middle turbinate (MT) is a key anatomical structure that serves as a surgical landmark, regulates airflow, and contributes to mucociliary clearance and olfaction. Its management during endoscopic sinus surgery (ESS) remains controversial, as surgeons must balance improved access with the preservation of nasal function. In this review, we summarized recent results on MT resection versus preservation. We conducted a narrative review using PubMed, Medline, and Ovid Science Direct covering the last 10 years (2016–2025), including English-language studies on the outcomes of MT resection versus preservation in ESS and excluding those lacking MT management details. We synthesized the data narratively without statistical analysis. Evidence indicates that selective MT resection could improve surgical access, reduce synechiae, and enhance sinus patency. Moreover, certain studies described improved symptom relief and olfactory outcomes. Reported drawbacks include minor bleeding, crusting, and loss of a key landmark for revision surgery, though the risk of major complications (e.g., empty nose syndrome) appears minimal. Selective MT resection is a safe adjunct to ESS, offering better access and reduced synechiae, with a low risk of major complications.